Woman dies after unexpected bleeding during surgery for ectopic pregnancy

Leon Kan, 30 Jun 2017

Although laparoscopic procedures are common, it is not the first time the surgical procedure has resulted in a ruptured aorta, causing massive bleeding.

In Dublin, surgery to remove a growing ectopic pregnancy ended in a tragic loss of life when 34-year-old Malak Thawley started bleeding unexpectedly during surgery.

Thawley, a teacher, first discovered she had an ectopic pregnancy in her right fallopian tube following a seven week scan. At the recommendation of her doctors, Thawley and her husband agreed to carry out a surgery to remove the ectopic pregnancy owing to the high risk of an internal rupture.

Unfortunately, shortly after the surgery began, a tear in Thawley’s abdominal aorta caused an uncontrollable bleed which ultimately led to her death on 8 May 2016.

Doctor’s first maternal death

Other than her ectopic pregnancy, Thawley was perfectly healthy and reported no pain prior to the surgery. The doctor in-charge, Dr. David Crosby, had successfully completed 92 laparoscopic procedures prior to the operation.

“This was the first maternal death I have been involved in,” said Dr Crosby.

During the surgery, Dr. Crosby identified a large volume of blood in the abdominal cavity and immediately informed Dr. Declan Keane, consultant obstetrician and gynaecologist, and a team from St. Vincent’s hospital to assist.

Upon arriving, Dr. Mary Barry, consultant vascular surgeon at St. Vincent’s hospital, identified that it was indeed an abdominal aorta bleed, however, things only went downhill from there.

Hospital unprepared for emergency case like this

While a ruptured abdominal aorta is listed as one of the possible surgical complications, it was the manner in which the complicated situation was handled which sparked the need for an inquest. The initial inquest encountered several issues that could have hampered the efforts to save the woman’s lives.

For starters, vascular clamps were not available in the hospital and had to be sent from a nearby clinic. Without vascular clamps, the surgical team would not be able to contain the bleeding effectively.

The severity of the situation only continued to worse as the surgery was done on a Sunday where the number of active staff was at its lowest. As a result, there was trouble contacting the laboratory for blood cross matching and subsequent delays in blood delivery.

As a result of the tragic incident, Thawley’s husband, Alan Thawley, was so distraught he could not bring himself to attend the inquest on his wife’s death. At the advice of his psychiatrist, her husband was recommended not to attend the inquest for his personal wellbeing despite him having prepared a statement that was to be read at the end of the inquest.

Nevertheless, the statement was still passed on to the head of the inquest as per the wishes of her husband. The result on Thawley’s inquest is soon to be heard.

Past cases of ruptured ectopic pregnancy

Although Thawley’s case is the first to be publicised, a similar incident had occurred in 2015 at a hospital in Manchester. The patient, who cannot be identified, was 22 years old at the time and was found to be 11 weeks pregnant when she was admitted for a ruptured ectopic pregnancy.

There, the decision was to undergo a laparoscopic surgery for the removal of her fallopian tubes as a life saving measure. Unfortunately during the surgery, the surgeon punctured her aorta several times causing a massive amount of bleeding. The situation quickly spiraled out of control till the point where blood transfusions and CPR had to be administered to keep the patient alive.

In the end, oxygen starvation had set its course and the patient was bound to a come for several weeks and had suffered severe brain damage. When she finally awoke, she had become a total hemiplegic, unable to talk and doubly incontinent.

Even after neuro-rehabilitation, the patient’s condition hardly improved as she remained wheel-chair bound for the rest of her life while requiring permanent aides. The incident came to a close when the hospital and the NHS agreed to pay damages worth £8 million to the patient and her family. MIMS